Abstract
The demographics, clinical features, and histopathological classification of orbital space-occupying lesions in adults have not been widely described in our part of the world except for the pediatric population. In this retrospective study, we collected 110 consecutive adult patients (18 years and older) with orbital lesions (excluding lacrimal gland lesions) that were diagnosed histopathologically in two tertiary eye centers in Riyadh, Saudi Arabia (January 2000 to July 2017). Patients with thyroid-related orbitopathy, infectious, and inflammatory/pseudo-inflammatory lesions were excluded. We had 60 males (54.5%) and 50 females (45.5%). The mean age at presentation was 51.4 years (range 19–99). Proptosis was the most common clinical presentation (mean duration 15.4 months). The orbital lesions in order of increasing prevalence were: lymphoproliferative lesions in 26.4%; vascular in 21.8%; secondary tumors in 14.6%; neurogenic in 13.6%; structural in 10.0%; soft tissue tumors 8.2%; then metastatic tumors (2.7%) and others (extramedullary leukemia, fibrous dysplasia, and histiocytic lesion: Rosai-Dorfman disease): one case each. Gender distribution was varied in lymphoproliferative disorders compared to vascular lesions. Cavernous hemangioma was the most common vascular lesion (83.3%) and schwannoma was the most common neurogenic tumor (60%). Secondary lesions extended to the orbit mostly from eyelids in nine out of 16 or conjunctiva in four out of 16 cases. A favorable outcome was observed in about 80% of patients who underwent excisional biopsy. The rest encountered local recurrence of the tumors, growing of residual lesions, and recurrence with further invasion to nearby structures. We concluded having a similar demographic pattern of orbital lesions in adults as has been universally reported. We have fewer secondary tumors. We have summarized the pathological profile of adult orbital lesions according to patients’ age, gender, symptoms, and location of the lesion as a baseline guide for proper diagnosis of any orbital mass prior to surgical management planning and for future prognostic studies.
Highlights
Different types of neoplastic and non-neoplastic lesions can affect the orbit
Secondary orbital tumors are defined as neoplasms that have reached the orbit by direct extension from adjacent structures such as the eyelids, conjunctiva, intraocular tissues, paranasal sinuses, nasopharynx, and cranial cavity
We identified 110 adult patients with orbital space-occupying lesions and histopathologically verified tissue diagnoses who were seen, managed, and followed up during the period encompassed by this study (17 years)
Summary
Different types of neoplastic and non-neoplastic lesions can affect the orbit. Orbital lesions can be classified according to the site of origin into primary, secondary, and metastatic. Shields et al [2] have proposed a thorough classification of orbital space-occupying lesions, in which orbital lesions were categorized into cystic, vasculogenic, peripheral nerve, optic nerve and meningeal, fibrocytic, osseous and fibro-osseous, cartilaginous, lipocytic and myxoid, myogenic, lacrimal gland, primary melanocytic, metastatic, lymphoid and leukemia, secondary, histiocytic, thyroid-related orbitopathy, other inflammatory, and miscellaneous. This classification is based on the tissue type which allows an organized thinking and easy categorization to the ophthalmologist and the pathologist. A modified classification (Appendix 1) has been used in the present study due to lesser number of cases studied and the lack of cases in some of the above categories, which has been followed by other group of authors in one of the centers and it allows easier comparison from one published series to another [3]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
